Provider Demographics
NPI:1548824782
Name:SALAZAR, CLIFORD M (PSRS, L1C)
Entity type:Individual
Prefix:
First Name:CLIFORD
Middle Name:M
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:PSRS, L1C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W TUDOR RD APT 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6530
Mailing Address - Country:US
Mailing Address - Phone:907-231-6571
Mailing Address - Fax:907-273-4085
Practice Address - Street 1:3001 C ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3913
Practice Address - Country:US
Practice Address - Phone:907-273-4024
Practice Address - Fax:907-273-4085
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist